THE SOURCE BLOG

HEALTHCARE MARKETS

A New York Times article came out today highlighting how hospital mergers result in higher healthcare prices to patients, based on research and analysis conducted by UC Berkeley’s Nicholas C. Petris Center. While hospitals claim that consolidation would save consumers money, the opposite is true due to reduced competition resulting from the consolidation. In addition to continued consolidation of hospitals across the country, the article suggests there is a growing trend of large hospital systems buying up doctors’ groups and medical practices. According to Richard Scheffler, Director of the Petris …

Happy November! We hope you are enjoying football season and preparing for turkey! In this edition of the Source Roundup, we cover five academic articles and reports from October. The topics this month include (1) the popularity of telemedicine for employers and employees, (2) an integrated health care system that combines ACO and bundled payment, (3) health spending growth in the coming years, (4) Maryland’s new initiative reduced hospital utilization and costs, and (5) how to remedy recent generic drug price hikes. Telemedicine Is More Widely Available, But Take-up …

This coming election, Palo Alto and Livermore voters will decide whether to cap health care pricing to 115% of direct patient care and quality improvement costs. Officially known as the Accountable and Affordable Health Care Initiative, and colloquially as Measure F for Palo Alto and Measure U for Livermore, these local initiatives face opposition from opponents who assert that federal and state laws preempt and invalidate the measures. On its face, this could have spelled the end to these measures. Preemption is a tried and true way to overturn local …

On October 15, 2018, Health Affairs hosted a forum in Sacramento called “Improving Care for Californians.” Two unifying themes emerged from the three panels. First, there is a growing tension between integration and consolidation in health care. Some panelists presented data that demonstrated that integrated health delivery networks often provide better and more integrated care, but that when healthcare delivery markets become highly concentrated, prices tend to increase. Second, the panelists discussed substantial improvements in healthcare in California, but all agreed that substantial work remains to be done to improve …

A Texas high school teacher recently made headlines after getting a $108,951 bill when a heart attack sent him to an out-of-network hospital. The ambulance rushed Drew Calver to the nearest emergency center, which his insurance did not cover, leaving him with an astronomical surprise medical bill. Unfortunately, surprise medical bills are becoming a ubiquitous part of health care in America. The question is: why? Most people have insurance, but insurance doesn’t cover everything. So when Calver was treated at an out-of-network facility, his insurance paid only $55,840 towards the …

It’s been an eventful month for healthcare litigation and enforcement action. Following coverage in last month’s Litigation and Enforcement Highlights, we revisit and follow up with significant new developments in SB 17 litigation and the CVS-Aetna and Cigna-Express Scripts mergers. Additionally, we take a peek at another major healthcare merger on the horizon. PhRMA Refiles Lawsuit Challenging California’s SB 17 Last month on The Source blog, we reviewed the California federal court’s dismissal of PhRMA’s legal challenge against SB 17 on procedural grounds and noted that plaintiff will likely …

Within the past few months, federal agencies passed two major healthcare regulations that could have significant consequences to the healthcare market. The Department of Labor (DOL) issued a final rule on Association Health Plans (AHPs) that expands the definition of “employer” under the Employee Retirement Income Security Act (ERISA), and the Departments of Health and Human Services (HHS), Labor, and Treasury issued a final rule that expands access to short-term, limited-duration coverage plans (STLDs). The two plans should not be conflated with each other as they offer health insurance coverage …

Welcome to October! We hope you are getting your costumes picked out and finding those deals to stock up on trick-or-treat candy. In this edition of The Source Roundup, we review five academic articles and reports from September that stood out to us. This month we look at (1) price inflation in the California fully-insured large group market, (2) forward motion in drug price transparency laws, (3) the future of pharmaceutical reference pricing in the U.S., (4) lessons learned from California’s competitive healthcare model, and (5) paths to universal coverage …

In this month’s Litigation and Enforcement Highlights, we recap two small but meaningful wins in courts for state legislation aimed at controlling rising drug prices. We also take a peek at the newest developments of two potential mega mergers and the legal challenge against the Affordable Care Act, both of which could change the landscape of the healthcare industry. Judge Boots Challenge Against California’s Transparency Law on Technicality In the latest development of the legal challenge against California’s recently passed SB 17, the U.S. District Court for the Eastern …

Happy September! We hope you’ve enjoyed the Labor Day weekend and ready for the fall! In this edition of The Source Roundup, we cover five academic articles and reports from July and August. This month we look at (1) monopoly in the ACA marketplace; (2) the recent Ohio v. American Express U.S. Supreme Court decision; and a trio of articles that examine accountable care organizations in terms of (3) ACO growth in 2018; (4) ACO effectiveness in reducing health care costs; and (5) the proposed changes to ACOs in the …